In general, a test should be obtained when one suspected result will lead in one direction, and a different result will lead to a different treatment. If the likely course of treatment is unchanged, then the test is often unnecessary.
Your healthcare provider should be able to determine if you meet specific criteria, known as Ottawa criteria, that predict the likelihood of fracture, and thus the need for an X-ray. These criteria are based on the location of tenderness and the ability to walk four steps.
In many situations, patients have unnecessary ankle X-rays after sustaining a sprained ankle. A good clinical examination can help prevent these unnecessary tests.
One problem with MRIs of the spine is that once you’ve grown past your teens, you probably have normal findings on your spine MRI that may be interpreted as abnormal. For example, disc bulging is commonly seen in healthy, young people with no back pain. This finding is seldom the cause of back pain and can confuse patients trying to find the source of their pain.
MRIs and X-rays are seldom needed to diagnose back pain and usually are only performed if standard back pain treatments are not effective. There are also some warning signs your healthcare provider may look for to determine if imaging is necessary, but for the vast majority of patients, these are not helpful tests.
The problem is, many blood test to diagnose types of arthritis can be falsely positive. That means that the result may be positive without the diagnosis of the underlying condition being present. For example, tests for rheumatoid arthritis (RA) can be positive in patients without RA, and may be negative in patients with RA.
Again, that is not to say that blood tests have no utility, but excessive use of these tests may lead to unnecessary treatment with potentially dangerous medications. Before obtaining a blood test, your healthcare provider should consider the possible diagnoses and ensure that the tests are performed for specific reasons, not just fishing for a possible problem. As stated above, if obtaining tests is just a fishing expedition, the results may prove to be falsely reassuring or lead to a misdiagnosis.
If surgeons operated on all elderly people with rotator cuff tears, they would be very busy. The truth is, that most rotator cuff tears, especially in patients over the age of 60, will improve with simpler, nonsurgical treatments.
New data is suggesting that labral tears are being diagnosed excessively in young patients with shoulder MRIs. Again, it is important to make sure any MRI findings are correlated to examination findings, and it is not just the test result that is being treated.
Having an abnormal bone density test may guide treatment, but the treatments often involve medications that can have significant side-effects. Patients who don’t need a bone density test may be best served by waiting until they meet appropriate criteria for the test.
